Lateral Ankle Instability: MR Imaging of Associated Injuries and Surgical Treatment Procedures

Abstract

Chronic ankle instability has been defined as the development of recurrent ankle sprains and persistent symptoms after initial lateral ankle sprain. The diagnosis of ankle instability is usually established on the patient's history, physical examination, and radiographic assessment. Patients have signs of both functional and mechanical instability, and the repetitive, chronic nature of the injury may lead to intra-articular and periarticular pathologies. This article discusses the incidence, etiology, and magnetic resonance (MR) imaging of these pathologies, reviews the surgical treatment procedures for lateral ankle instability, and presents the postoperative MR imaging findings.

Deltoid Ligament and Tibiofibular Syndesmosis Injury in Chronic Lateral Ankle Instability: Magnetic Resonance Imaging Evaluation at 3T and Comparison with Arthroscopy

“…CLAI is defined as the development of recurrent ankle sprains and persistent symptoms after an initial lateral ankle sprain. The diagnosis of ankle instability is usually established following a careful history, physical examination, and radiographic assessment ( 3 4 ). Surgical treatment in CLAI patients may be indicated in the context of persistent symptoms that do not respond to non-operative management ( 4 ).…”

“…The diagnosis of ankle instability is usually established following a careful history, physical examination, and radiographic assessment ( 3 4 ). Surgical treatment in CLAI patients may be indicated in the context of persistent symptoms that do not respond to non-operative management ( 4 ). However, according to previous reports, between 13% and 35% of patients continue to experience ankle symptoms after surgical intervention, despite the success of the original procedure ( 5 ).…”

Revisiting the Prevalence of Associated Copathologies in Chronic Lateral Ankle Instability: Are There Any Predictors of Outcome?

“…Specifically, use of the Brostrom technique (with or without the Gould modification) to achieve an anatomical repair is considered the first-line standard approach by many. [3][4][5][19][20][21] Outcomes from anatomical ligament repairs are overwhelmingly favorable. 19,21 However, a significant number of patients will continue to experience foot and ankle pain, sometimes without identifiable cause.…”

“…2,[4][5][6] Such changes include stretching of the lateral ankle ligament complex (anterior talofibular and calcaneofibular ligament, posterior talofibular ligament rarely), irritation of the peroneal structures (tendons and tenosynovium of the brevis and longus muscles), wearing of articular cartilage (osteochondral lesion), and development of intra-articular scar tissue and osteophytes (leading to ankle impingement). 2,[4][5][6][7][8] A few studies have attempted to document the prevalence of these copathologies; however, these studies depict a wide range of prevalence. [9][10][11][12][13] For example, the presence of osteochondral lesions ranges from 23% to 93%, whereas the occurrence of peroneal pathology has been cited to be as low as 28% (though most studies report rates above 50%).…”

Evaluating and Differentiating Ankle Instability

“…Traditionally, total anterior translation .9 mm or translation .5 mm (or both) compared with the contralateral side is thought to indicate significant laxity of the ATF, whereas a talar tilt angle .108 in total or more than 58 greater than the contralateral limb indicates pathologic laxity of the CF ligament. 44,45 However, other authors 19,45,46 have suggested 28,[38][39][40][41] slight variations to these ranges, as well as concerns about high levels of variability and inconsistency.…”